Turkish Neurosurgery
Pediatric cerebral cavernous malformation: A single-centered experience of 23 cases
Yavuz Aras1, İlyas Dolas1, Duygu Dölen1, Tugrul Cem Unal1, Duran Sahin1, Cafer Ikbal Gulsever1, Pulat Akın Sabancı1, Altay Sencer1
1Istanbul University Istanbul School of Medicine , Neurosurgery, Fatih/İstanbul,
DOI: 10.5137/1019-5149.JTN.36915-21.2

Aim:Cavernous malformations (CMs) are angiographically occult, low-flow lesions, with an annual risk of hemorrhage of 0.7%-1.1%. Pediatric CMs are larger, more prone to bleed and more likely to require surgical intervention than adult CMs. We aimed to describe and evaluate the clinical and radiological characteristics of pediatric CM and the surgical approaches and outcomes of a single center.Material and Methods:We retrospectively reviewed pediatric patients with CMs that were treated in our center between 2010 and 2020. Radiological, clinical, and demographic features, as well as treatment details were evaluated. Results:Of 23 patients, 12 were male, and 11 were female. Two patients with multiple CMs had a family history. The most common symptoms were headaches (9/23, 39.1%) and seizures (9/23, 39.1%). Twenty patients had single lesions and three patients had multiple lesions. According to Zabramski classification, eight (34.7%) patients had type 1, 11 (47.8%) had type 2 and four (17.3%) had type 3 lesions. Thirteen patients had recurrent preoperative hemorrhages and nine had increased lesion size. Seven patients (30.4%) had coexisting deep venous anomalies in the CM vicinity. Twenty-one patients underwent microsurgical resection (5/23 simple lesionectomy, 16/23 lesionectomy + resection of the surrounding hemosiderin ring). All lesions were completely resected. No surgical mortalities or major complications occurred. Conclusion:Since pediatric CMs are more aggressive than adult CMs, they should not be underestimated. Microsurgical total resection should be the first treatment choice where possible. We concluded that early surgical treatment and resection of perilesional hemosiderin-stained tissue, when feasible, yield the most favorable results at long-term follow-up including seizure outcomes.

Corresponding author : Duygu Dölen